Monday, April 6, 2015

For 40 years Americans have been eating fewer eggs, butter and red meat with saturated fat and cholesterol because US government policy makers told us not to. We were told that dietary saturated fat and cholesterol were bad for our health and caused heart disease. Manufactured foods such as margarine, egg substitutes, and low fat products laden with sugar or high fructose corn syrup to make them palatable were touted as the healthy way to go.

I have been advising my patients for most of my practice to stay away from the manufactured foods and eat whole foods, including eggs, red meat and butter. And now, the US government finally agrees with me.

In February 2015 the 572-page Scientific Report of the 2015 Dietary Guidelines Advisory Committee was released. Buried on page 91 it states, "...available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum (blood) cholesterol....Cholesterol is not a nutrient of concern for overconsumption."

When the original recommendations were made in the 1960s and 1970s, the government policy relied on a kind of science called epidemiological or observational studies. In these studies researchers follow large groups of people over many years. However, these studies are limited in that they can only show an association between two things, and not that one causes the other. Therefore a hypothesis can be formed from these studies, but it takes more rigorous studies to prove them.

There are still dietary guidelines in the current report that I don't agree with. They continue to recommend reducing saturated fats, to the point of recommending that even lean meat be removed from the list of healthy foods, even though several recent meta-analyses have shown that there are no studies that prove that saturated fats cause heart disease.

And they continue to recommend limiting salt intake, even though in 2013 an authoritative study by the Institute of Medicine contradicted that recommendation.

While there may be a general correlation between high serum levels of cholesterol and heart disease, it is only oxidized cholesterol that leads to atherosclerotic plaque (hardening of the arteries). High levels of non-oxidized serum cholesterol are actually protective and essential to life and all cells. Studies of the elderly show that those with low cholesterol levels have higher death rates than those with high cholesterol levels.

We should be focusing on what oxidizes the cholesterol. Inflammation in the arteries causes oxidation of cholesterol, platelet aggregation and atherosclerotic plaque formation. Rather than focusing so much on the cholesterol levels, in our office we test Lp-PLA2 levels, a marker for inflammation and plaque in the arteries, and Cardiac C-reactive Protein, a marker for inflammation in the body.

What causes inflammation in the arteries? The two most common causes are high blood glucose and insulin levels and high Homocysteine levels. Anything else that causes inflammation in the body, such as autoimmune diseases, chronic infections, etc. can also increase inflammation in the arteries.

The increase of consumption of low fat, high simple carbohydrate diets high in sugar and processed grains has caused an explosion of pre-diabetes and diabetes. The insulin levels rise to try and lower the blood glucose levels and try to drive glucose into the cells. The cells start to become resistant to the high levels of insulin, and blood glucose levels rise.

When blood glucose rises, it attaches to the proteins in a process called "glycosylation," which damages the protein and cells. The amount of glycosylation in the body is measured by the Hemoglobin A1C. If that level is elevated, is shows that damage is already being done in the body and in the arteries, even though it may not yet be considered full-blown diabetes.

When insulin levels rise, blood pressure rises, triglycerides and sometimes cholesterol increases, and it causes inflammation in the body and in the arteries.

Therefore, the recommendations by the government and the American Heart Association to cut down on dietary fat and cholesterol may have even worsened our health. By cutting out meat and eggs, we have eaten more grains, pasta, sugar, high fructose corn syrup and polyunsaturated fats. Over the past 50 years, Americans have cut saturated fat intake by 25% and increased carbohydrates by more than 30%. However, well done studies are showing that a diet high in sugar, refined grains and polyunsaturated fats increases the risk of obesity, diabetes and heart disease much more than a diet high in natural fats and cholesterol.

Homocysteine is a non-protein amino acid, important in the synthesis of methionine and cysteine. High Homocysteine levels can cause endothelial (cells that line the inner arteries) cell injury, causing inflammation and atherosclerotic plaques.

High levels of Homocysteine are caused by a reduction in three simple nutrients: Folate, B-12 and B-6. Today most of our processed foods contain these nutrients as additives. Red meat and whole grains have higher levels of these vitamins. However, around 40% of the population has a genetic defect which keeps the body from creating the activated form of these vitamins which are necessary to reduce Homocysteine. This is a mutation of the MTHFR genes (See my blog from February to find out more about this mutation). If you have a family history of heart disease, make sure you are tested for this mutation.

So what is my advice on reducing heart disease?

Check inflammatory markers Lp-PLA2 and Cardiac C-reactive protein

Check Homocysteine levels

Reduce oxidation of cholesterol with high levels of anti-oxidants such as those found in SpringTree SuperMulti Plus.

Balance insulin and blood glucose with a whole foods low carbohydrate diet. Don't forget the natural fats--they balance blood sugar and give us energy in place of the carbs. Also consider using SpringTree Glucose Balance

Reduce Homocysteine levels with the activated forms of B-12, folate and B-6, called methylcobalamine. 5-MTHF, and P-5-P, as found in SpringTree Methylation Factors.

Reduce inflammation with fish oil

Reduce inflammation with proteolytic enzymes and herbs such as turmeric, found in SpringTree's Pain and Inflammation supplement.

Saturday, April 4, 2015

Diabetic Peripheral Neuropathy (DPN) is often one of the most painful results of diabetes. The Neuropathy Association reported in 2013 that neuropathy in the United States is "skyrocketing." Between 15 and 18 million Americans have DPN. DPN affects the nerves in the hands and feet, causing numbness, tingling and pain. Nerve problems may also occur in the digestive tract, the heart, eyes and other organs.
The pain
can be a "pins and needles" feeling, a burning sensation, and/or shooting and electric shock pains.

There is often confusion in the medical profession as to how diabetes causes DPN. Some theorize that the excess blood sugar affects the protective coating on the nerves. Others believe decreased blood flow to the nerves can cause damage.

However, there is more evidence forming that the largest cause of DPN and even peripheral neuropathy not related to diabetes is a B-12 and/or folate deficiency. B-12 deficiency causes demyelination of the nerves, allowing damage to the nerves and increased sensitivity. Folate deficiency reduces the expression of Nerve Growth Factor and increases lipid peroxidation.

Deficiencies of both B-12 and folate can cause a swollen, geographic or cracking tongue and beaded vertical ridges on the fingernails.

Causes of B-12 deficiency include low stomach acid (common in diabetes), a vegan diet, celiac disease from gluten, stomach surgery (including surgery to reduce obesity), and less common, pernicious anemia, a lack of intrinsic factor in the stomach.

A concerning cause of B-12 deficiency is the use of the most common diabetic medication Metformin (Glucophage). Metformin in general is a good medication for diabetes, but it causes B-12 deficiency, and too many physicians are not watching the B-12 levels of their patients on Metformin.

Causes of folate deficiency include poor diet with inadequate vegetables, excessive alcohol use, medications such as birth control pills, dilantin for seizures, antibiotics with trimethoprim such as Bactrim and Septra, chemotherapy agents such as methotrexate, often used for autoimmune diseases such as rheumatoid arthritis, celiac disease, giardia infection, and low stomach acid.

More recent studies are showing the large number of diabetics with the MTHFR DNA mutation. This mutation keeps the MTHFR enzyme from adding a methyl group (1 carbon and 3 hydrogen atoms) to B-12 and folate, considered the activated form of B-12 and folate and necessary for the cells to be able to use them. An MTHFR mutation increases the risk of both diabetes and nervous system disorders, especially peripheral neuropathy. (See my blog post of Feb. 20, 2015 for more information on this common mutation.)

Many studies have been done using folate and B-12 as treatment for peripheral neuropathy. The FDA has approved a "medical food" by the name of Metanx for the treatment of DPN, which includes methylcobalamine (methyl B-12), 5-MTHF (methylfolate) and P-5-P (the activated form of B-6). This medication has been proven to improve DPN, but it is expensive and insurance companies often don't pay for it.

SpringTree Methylation Factors contains the same ingredients plus more to improve the functioning of the activated forms of B-12, folate and B-6. Our SuperMulti Plus also contains 1000 mcg each of the methylated forms of B-12 and folate, along with high antioxidants and glucose tolerating factors which help reduce the damage from high insulin and blood glucose.

Our treatment recommendations for DPN include:

a high protein and fat, including red meats, high vegetable, no grain and low carbohydrate diet (see previous blogs)--diet is VERY important!

SpringTree Methylation Factors--start with 1 capsule/day and increase to 3/day if there are no negative symptoms. (If there is increased nervousness, pain, headache, etc. you could be experiencing over-methylation. Take niacin 50-250 mg. to stop the symptoms)

SpringTree Pain and Inflammation 3 capsules one to 3 times a day to reduce the inflammation and the pain caused by DPN

We also highly recommend getting tested for the MTHFR DNA mutation. If it is positive we also recommend detox protocols.

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